Can adapted motivational interviewing improve uptake of surgical or laser treatment for glaucoma in Nigeria: randomized controlled trial

Purpose: To assess whether adapted motivational interviewing has any impact on the proportion of participants who subsequently underwent surgery or laser treatment for glaucoma. Methods: A single site randomized controlled trial in Bauchi, Nigeria. Participants were new patients with a confirmed diagnosis of primary open angle glaucoma in one or both eyes, where surgery or laser was recommended. Intervention was a session of motivational interviewing adapted for glaucoma and the local context, using an interview guide based on local qualitative research. Participants were randomly allocated to intervention or usual care. Usual care was routine explanation by an ophthalmologist and an educational pamphlet. After the interview, a 12-item Working Alliance Inventory questionnaire was administered to patient-interviewer pairs to assess the collaborative relationship. Results: 276 glaucoma patients participated; 70% males. 135 (49%) were assigned to adapted motivational interviewing and 141 to usual care. All received the intervention as allocated. Uptake (i.e., the proportion who underwent treatment) of laser or surgery in the motivational interviewing group was 52% compared with 45% in the usual care group (risk difference 7.2%, 95% confidence interval -4.5-18.9%). Mean Working Alliance Inventory scores were 68.0 for interviewers and 68.5 for participants with a combined reliability coefficient of 93.9% (i.e., high internal consistency and reliability). Conclusion: We observed only a small increase in the uptake of surgery or laser with motivational interviewing compared with usual care which was not statistically significant. Although only 1 in 2 patients accepted surgery or laser in this trial, this is a much higher proportion than in other studies. Key words: Glaucoma, Motivational interviewing, Treatment uptake, Africa